CONGRESS ABSTRACT

Since the publication of the 2019 ESC/EAS Guidelines and their last update in 2025 (1) for the management of dyslipidemias, there is a progressive widespread use of statins because of their impact in reducing the incidence of cardiovascular disease. Statins are generally safe and tolerable. A mild myalgia is the more frequent symptom complained by patients (2) but only in rare cases (3) statins cause serious muscle damage, with weakness and elevated levels of creatine kinase (CK). In the majority of such cases, the patients recover spontaneously after the statin treatment discontinuation (4,5). We describe a case of a 63 years old woman with a mild hypercholesterolemia (total cholesterol 204 mg/dl, LDL 121 mg/dl) who started a treatment with statin (atorvastatin 20 mg OD) since 2018 for a high atherosclerotic risk due to a familiar hypercholesterolemia, high blood pressure and aortic arch’s atherosclerosis. On June 2022 the patient (pt) complain a worsening of muscle fatigue, myalgia with increased value of CK (3237 IU/l), never checked before. Symptoms improved after interruption of the statin and CK reduced (574 IU/l). Statin was substituted with Evolocumab and Ezetimibe. During follow-up the pt was asymptomatic but CK progressively increased (1369-1734-2237 IU/l). Ezetimibe was stopped. A clinical investigation excluded a thyroid disease or a neuromuscolar disease. All laboratory autoimmune assays were within normal range but high level of autoantibodies against 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase was detected (141 A/mL; cutoff 0-20) . In the hypothesis of an autoimmune myopathy induced by statin, an electromyography that documented a mild muscle sufferance was performed. Conclusion. Autoimmune myopathy induced by statins is rare but it has to be considered in presence of myalgia and elevated values of CK (> 10x normal value), persistently also after interruption of the statin (6). In this case immunosuppressive treatment is a challenge because of lack of randomized treatment study but at the same time it has to be considered in case of progression of the muscle disease and symptoms.